[The treatment of Basedow's disease. The agony of selection]

The treatment mode of Graves' disease should be chosen individually for each patient. This requires a thorough knowledge of the advantages and disadvantages of the various methods, and also bias-free interdisciplinary cooperation. Surgery reestablishes euthyroidism in about 80%, with 10% becoming hypothyroid. In centers practising more radical surgery hypothyroidism has developed in up to 49% and there is now evidence of occurrence of late hypothyroidism in the same way as after radioiodine. Radioiodine is cheap and causes minimal inconvenience to the patient. Because prevalence of hypothyroidism rises in a cumulative way over decades, lifelong follow-up is necessary with an examination every 1 to 2 years. The genetic risk and the danger of thyroid carcinoma have been shown to be negligible by gonadal dose calculations and by longterm prospective follow-up. Antithyroid drugs inhibit incorporation of iodide into thyroglobulin and produce rapid clinical improvement. It seems probable that, in longterm treatment, they also specifically suppress the synthesis of thyroid-stimulating immunoglobulins. The significance of "allergic" reactions such as skin rash, leukopenia and agranulocytosis is usually overestimated. The hematologic side effects are rare, dose-related and reversible in most cases. The major drawback of antithyroid drugs is the high recurrence rate (50%) of hyperthyroidism after cessation of therapy. It is still undecided whether a long course of treatment (one year or longer) produces better longterm results than short courses.